128 patients scheduled for total knee arthroplasty were randomized to intervention with either patient-specific guides (PSG) or conventional instrumentation. Participants allocated to PSG were managed with pre-operative planning using either Signature (Biomet Inc.), TruMatch (Depuy Inc.), Visionaire (Smith & Nephew Inc.), or Patient-Specific Instruments (Zimmer Inc.). Patients allocated to the conventional group were treated with standard intra- and extramedullary instrumentation. The results indicated that there was no significant improvement over conventional instrumentation offered by PSGs. Additionally, PSGs had to be abandoned intraoperatively in 14 cases, and outliers in tibial component alignment were significantly higher in the PSG cohort.